Maggie McKay (Host): When it comes to birth control, there are several options, one of which is the IUD, but how much do you know about it?

Alexandra Sasha Weigel, Certified Nurse Midwife with concordobgyn.com 

Maggie McKay (Host): OBGYN affiliated with Emerson Health is here to fill us in. Welcome to Health Works Here, a podcast from Emerson Health. I'm your host, Maggie McKay. Thank you for joining us today, Sasha.

Sasha Weigel, CNM: Thanks for having me.

Host: So let's begin with what is an IUD and how does it work?

Sasha Weigel, CNM: So an IUD is an intrauterine device. That's what it stands for. There are two types. There is a hormonal IUD and there is a non hormonal IUD. Both are made of flexible plastic, probably about two centimeters ish in size. And the difference between the two is essentially, like I said, one has copper which is a metal that actually prevents conception from happening by making, rendering sperm less movable. It changes the way they move. So there's no way a conception can happen. And the other one has hormones in it. And it's a progesterone hormone that's in them. The progesterone IUD works by increasing the cervical mucus to block sperm from entering the uterus. There are several types of these of varying sizes. And those basically release the same amount of hormones every day for a certain number of years. Between both kinds, they can range from 3 to 12 years.

Host: Wow, so you can have an IUD in your body for 12 years. I did not know that. Who should use an iUD?

Sasha Weigel, CNM: So, pretty much anybody who is comfortable with imagining something inside their body, something inside their uterus. It does require that you are okay and comfortable with using a speculum. That's the metal or plastic device that we would insert through the vagina to be able to visualize the cervix.

And the other thing to just underscore is that this is a contraceptive device, so it does prevent pregnancy. So if you are looking to get pregnant, this would not be something that you would consider.

There are certain structural, anatomical anomalies occasionally found in the uterus, and that is something that you would want to talk to your provider about and make sure that you are indeed a candidate for an IUD.

Host: What are the benefits of an IUD over other forms of birth control?

Sasha Weigel, CNM: One of the greatest benefits, I think, of an IUD is that it is extremely effective. It's one of the most effective forms of birth control out there, far superior to the condom, the patch, the pill, the shot, etc. It's 99 percent effective, which is essentially the most effective you can get unless you plan sterilization, such as a vasectomy.

Another wonderful benefit of an IUD is that it is long lasting. You do not have to think about it. It will be in your body and do its job and it's one last thing you have to think about every single day and in that way it's extremely convenient by comparison to let's say the pill which you have to remember to take every single day.

Host: Sasha, are there any other reasons women should use an IUD?

Sasha Weigel, CNM: Yeah, there are a number of reasons, in fact. For folks who have a very heavy period, using the hormonal IUD option can be a terrific way of reducing the amount of bleeding you have every month or say you have terrible cramps with your cycle every month. That also is something that the IUD can relieve. So we often, in fact, see people with one of the types of hormonal IUDs not even have periods at all, or just very light spotting. So that can be a real relief for somebody who's been struggling with heavy menstrual bleeding or possibly even anemia from all of that bleeding, which is low iron.

One of the IUDs is actually approved for reducing your risk of endometrial cancer in fact and we are seeing some research on the possibility of it lowering our risk for cervical cancer as well. So those are some exciting developments. Um, we also know that for folks who struggle with endometriosis which can be a terribly painful disorder with heavy bleeding and very intense pain. Uh, it can reduce the pain of this dramatically.

 Then lastly, I would say that the non hormonal IUD is safe for women who have active breast cancer and, a few other serious medical conditions where other hormonal options may not be available to them.

Host: Wow. So it's really a lot more than just birth control, it sounds like, as far as benefits. Are there any side effects with IUDs?

Sasha Weigel, CNM: Well folks really actually tend to report liking the side effects a lot of the time. As I said earlier, they can reduce your periods sometimes even to not having a period, so this can be a welcomed side effect. For some people who like the reassurance of getting a period every month to know that they're not pregnant, this can feel more like a side effect.

We sometimes see irregular bleeding in the beginning after insertion, something up generally around three months, but it tends to resolve after that. So if you can stick it out for three months, managing some irregular bleeding, some spotting here and there, it usually evens itself out as the body, you know, calibrates to this new device inside of it.

I'd say a side effect is the insertion. Um, it is short-lasting, however, it can be, you know, an uncomfortable event, and particularly uncomfortable for some people. But we have ways of mitigating that.

Host: So you mentioned insertion of an IUD. What do you tell patients to expect? What does it feel like? Do they need to prepare for it?

Sasha Weigel, CNM: My patients who are considering an IUD come in and have a chat with me. I like to go over all the options for birth control and make sure that this is the one that's best suited to them. And they feel most comfortable with. We come up with a plan, we do a quick check, a speculum exam just to make sure that they are comfortable with the speculum because that is required for the insertion process.

I will counsel them on, you know, those minimal risks, that are a possibility such as infection. And have them come back in another day after they've taken some ibuprofen, and, you know, prepared mentally for it. On the day of, when they come in, we can put some music on, we can take as long as we need, but essentially, it is a fairly straightforward and quick procedure. We start with a speculum exam. I'll clean the cervix. I have to stabilize the cervix, make sure it doesn't move with a small instrument. Then I need to measure the interior of the uterus with a very small blunt little stick so I can see how deep your uterus is and then I insert the device with a little inserter and then I remove the inserter once it's inside and then I snip the strings and the patient is good to go.

We might hang out there on the table for a little while to make sure she's comfortable. Sometimes you can feel a little lightheaded after, sometimes you can feel really crampy after. Sometimes you don't feel crampy at all. It's a real range of how folks react to it. I would say if there's concern for pain ahead of time, definitely taking some ibuprofen can be useful for pain management, and I'm always happy to prescribe an anti anxiety medication as well if that might be of use.

We can always give numbing medication to your cervix, which is the bottom part of your uterus which can help numb the area. And for folks who really struggle with the concept, but really want an IUD and don't think they can sit through the procedure that I just described. We can always do the procedure in an operating room under anesthesia.

Host: So, you've got it covered as far as making the patient as comfortable as possible. What about removal? What's that experience like? Because you said they can be in there for 12 years. What's it like?

Sasha Weigel, CNM: The removal is vastly more straightforward. What we leave when we insert the IUD are two very small, fine strings that emerge from the cervix, which is the bottom part of the uterus and kind of curl around the rim of the cervix and cannot be felt by the patient or their partner. Those strings remain in place there so that when it's time to remove it, whenever the patient wishes, we grasp those strings with a little instrument, kind of like a tweezer, and we pull those strings very gently, in fact, and it comes right out and that's about it.

I usually have the patient cough during the removal, and the length of time it takes to cough is how long it takes to get out.

Host: Oh, easy. It sounds very quick. So Sasha, is there anything else you would like women to know about IUDs in closing?

Guest: Yeah, I think that there's a lot of talk these days about how uncomfortable IUD insertions are, and they don't have to be. So I think it's really important if this is an, the idea of an IUD appeals to you because it's so effective, because it's so long lasting, talk to your provider about ways that we can administer this device to you and work with you in terms of getting the right pain management.

So I think that's an important thing to keep in mind that, the insertion process should not inhibit you from considering this as a good option for you. Number two, I think it's important to underscore over and over, this does not affect fertility, future fertility. As soon as this is removed, you return to your fertile state.

There are no repercussions for future fertility with the use of an IUD, even if it's in for 12 years. And also I think there's this understanding that we have our cycles, our periods and that is healthy and necessary for us. It is not unhealthy to not have a period. It is perfectly healthy because one of the ways that the medication works, the progesterone works, is it does not allow your body to build up a lining, which is what's shed during menstruation.

So when there's no lining to shed, you don't have a period and so that's what's happening here and it, there's nothing wrong with that or unhealthy or unsafe with that. Another thing just as an important reminder I think for folks considering this, it's a great option if you are breastfeeding. It's very safe for breastfeeding.

Some people are concerned about hormonal use when breastfeeding and they don't have to be. And a big question that always comes up is, do I gain weight? And you do not gain weight with an IUD.

Host: And so that's pretty much all we need to know. Yeah?

Guest: I think there's a lot of nuance to the IUD and it certainly, it's not for everybody. I think the first thing to really consider is, do I feel comfortable with something inside of me? And then if you are, let's go into the details after that.

Host: Well, thank you so much for sharing your expertise. This has been very useful information and we appreciate your time.

Sasha Weigel, CNM: My pleasure. Great talking.

Host: Again, that's Alexandra Sasha Weigel, and you can go to concordobgyn.com for information and to make an appointment. And if you found this podcast helpful, please share it on your social channels. And check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Emerson's Health Works Here podcast. Make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple podcasts, Google podcasts, Spotify, or wherever podcasts can be heard.